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REFERRAL FORMMADISONVILLE 200 Clinic Drive, 6th Floor, Jacksonville, KY 42431 Phone: 812.477.7246 Fax: 812.477.7240REQUIRED INFORMATION FOR ALL REFERRALSREFERRING PROVIDER Referring Provider: NPI

How to fill out 200 clinic drive 6th

How to fill out 200 clinic drive 6th

1. Begin by entering the address '200 Clinic Drive 6th' in the designated field.
2. Make sure to correctly include the apartment or suite number, if applicable.
3. Double-check the spelling and numerical accuracy of the address.
4. If filling out a physical form, neatly write the address in the provided space.
5. If filling out an online form, ensure that the address field is properly formatted and accepts the given address.
6. If there are any additional instructions or specific requirements related to the address, follow them accordingly.
7. Finally, review the completed form or submission to verify the accuracy of the entered address.

Who needs 200 clinic drive 6th?

1. The specific individual or organization who needs '200 Clinic Drive 6th' can vary depending on the context or purpose.
2. Potential entities who may need this address could include:
3. - Doctors or medical professionals working at a clinic located at '200 Clinic Drive 6th'
4. - Patients seeking medical care or appointments at a clinic located at '200 Clinic Drive 6th'
5. - Individuals or businesses involved in the medical field who have a professional affiliation with the clinic at '200 Clinic Drive 6th'
6. - Organizations or institutions coordinating medical events, seminars, or conferences at a venue located at '200 Clinic Drive 6th' or utilizing the address for correspondence purposes.

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What is 200 clinic drive 6th?

200 Clinic Drive 6th refers to a specific form or document related to a healthcare or clinical institution, often used for reporting or administrative purposes.

Who is required to file 200 clinic drive 6th?

Healthcare providers, clinics, or institutions that meet certain criteria set by governing bodies are usually required to file the 200 Clinic Drive 6th.

How to fill out 200 clinic drive 6th?

To fill out the 200 Clinic Drive 6th, gather all required information, follow the instructions provided in the form, and ensure accuracy before submission.

What is the purpose of 200 clinic drive 6th?

The purpose of the 200 Clinic Drive 6th is to collect necessary data for regulatory compliance, funding, or performance evaluation of healthcare services.

What information must be reported on 200 clinic drive 6th?

Information typically reported includes clinic details, patient demographics, service utilization statistics, and financial data.